Article

Adjunctive Valproic Acid for Delirium and/or Agitation on a Consultation-Liaison Service: A Report of Six Cases

University of California, Davis, Davis, California, United States
Journal of Neuropsychiatry (Impact Factor: 2.77). 02/2005; 17(2):232-8. DOI: 10.1176/appi.neuropsych.17.2.232
Source: PubMed

ABSTRACT The authors present six cases in which valproate was used in patients seen by a consultation-liaison service (CLS) to manage delirium and/or psychotic agitation. The intravenous (IV) preparation (Depacon, Abbott Laboratories) was used in two nothing by mouth (NPO) patients, while the liquid oral preparation (Depakene, Abbott Laboratories) was used via nasogastric tube (NGT) in the other patients. All of these cases had suboptimal responses and/or concerning side effects from conventional therapy with benzodiazepines and/or antipsychotics. In all six cases, the CLS use of valproic acid combined with conventional antidelirium medications resulted in improved control of behavioral symptoms without significant side effects from valproic acid. Consultation-liaison psychiatrists should consider the addition of valproic acid to control behavioral symptoms of delirium when conventional therapy is inadequate. This may be especially advisable when problematic side effects result from more conventional psychopharmacological management. Specifically, intravenous valproate sodium may be a viable option for NPO patients.

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    • "When evaluating bipolar patients, valproate is recommended as a drug of first choice if multiple mood episodes, irritability , aggressiveness, impulsivity, or hyperactivity are detected in the psychiatric history (Swann et al. 2002). A few studies have suggested valproate for controlling agitation and delirium in inpatients with severe physical diseases that do not benefit from antipsychotics or shortacting benzodiazepines (Kahn et al. 1988; Bourgeois et al. 2005). "
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    ABSTRACT: Delirium may present with hyperactive, hypoactive or mixed clinical pictures. The signs of hypoactive delirium are lethargy, confusion, apathy, hypersomnia, muttering, difficulty in maintaining attention, and difficulty in understanding and performing commands. Valproate is commonly used for the treatment of epilepsy and bipolar disorders. It is also used for the management of alcohol withdrawal delirium and agitative-aggressive deliriums. However, few reports are available about the valproate-induced delirium. In this report, we present a 46 years-old woman with bipolar disorder for 14 years. During her last two hospital admissions, she had been diagnosed with manic episode with psychotic features and she had received valproate. She experienced three hypoactive delirium episodes lasting 2-3 days throughout the treatment period of first week. The patient predominantly had the following signs; vomiting, hypersalivation, confusion, drowsiness, dysphasia, and hypoactivity. At the first day of delirium episode, serum valproate level was found to be within the therapeutic range (98.4, 117.1, and 65.6 mug/ml; respectively). In addition, she had normal results of cranial MRI, complete blood count, urine analysis, electrocardiogram, ALT, AST, albumin, bilirubin, BUN, creatinine and electrolytes. The serum ammonia level of the patient could not been measured due to limitations of laboratory facilities. The patient's consciousness improved dramatically 2-3 days after cessation of valproate. In conclusion, valproate can induce delirium at therapeutic blood levels in some patients via various mechanisms and this side effect has to be considered during valproate use.
    Turk psikiyatri dergisi = Turkish journal of psychiatry 01/2010; 21(1):79-84. · 0.43 Impact Factor
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    • "When evaluating bipolar patients, valproate is recommended as a drug of first choice if multiple mood episodes, irritability , aggressiveness, impulsivity, or hyperactivity are detected in the psychiatric history (Swann et al. 2002). A few studies have suggested valproate for controlling agitation and delirium in inpatients with severe physical diseases that do not benefit from antipsychotics or shortacting benzodiazepines (Kahn et al. 1988; Bourgeois et al. 2005). "
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